Report documents nurses’ worries about heart monitors

Vickie Kaminski, President and CEO of Eastern Health, said today it’s time to put the issue of concerns over cardiac monitors at the Health Sciences Centre to rest.

She said the Health Sciences Centre is the only area where complaints are being raised regarding the heart monitors.

She said the monitors are tools, not diagnostic devices, and nurses must remember that.

"They are safe and we have to help nurses adapt," she said.

She said the monitors will not be changed.

Nurses at the Health Sciences Centre have raised concerns over the cardiac monitors saying they are causing patient and safety issues, as well as putting nurses in a moral and ethical dilemma with respect to patient care.

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(Earlier story)

Nursing standards are being breached over troubles with costly cardiac monitors at the Health Sciences Centre and wireless signals are not the only fault, according to a document obtained by The Telegram.

“Along with patient and safety issues, we find ourselves in a moral and ethical dilemma with respect to our patient care,” the critical care nurses said in a report, presented to a group of Eastern Health managers and others in November.

The report details their concerns about the monitors and notes specific occurrences with patients, including two who bled into their beds and another who had to be revived, as well as instances of missed arrhythmias.

By the time they made the presentation, the nurses reported they repeatedly documented issues in emails to management, among others.

The worried nurses work in intensive, critical and cardiac care where the Draeger monitors have been installed to track physiological signs, such as electrocardiogram (ECG), heart rate, oxygen concentration, blood saturation level and blood pressure.

When problems with the monitors hit the media this month, Eastern Health attributed the glitches at the Health Sciences Centre to the use of 28 telemetry — wireless-remote — devices.

Those wireless devices were an addition to the 53 hard-wired monitors.

Eastern Health has said the issue is the wireless connection between the patient and the central monitoring system cuts out sometimes when the patient is moving, an explanation repeated last week by Health Minister Susan Sullivan.

But the document obtained by The Telegram traces the problems back to April 2011 when the monitors were first installed at the medical-surgical intensive care unit and the cardiovascular intensive care unit at the Health Sciences Centre.

Eastern Health has already spent $7.3 million installing the system in several facilities, but the Health Sciences Centre is the only one so far with wireless monitors.

The nurses said they have concerns about wireless capability at Health Sciences, the problems persisted before those telemetry devices were installed in September 2011.

The system has been giving off false alarms and causing other problems, including demanding too much time away from nursing duties as nurses troubleshoot the devices, the report said.

There are serious concerns about incidents involving patients, including ST-Segments, part of an electrocardiogram, that nurses say must be monitored continuously 24-48 hours after an operation to avoid possible deadly complications.

“ST monitoring has been an unresolved issue since April,” the nurses wrote in November.

“A portion of patients in all three units and telemetry are unable to analyze ST segments continuously. Excessive nursing time is being spent trouble shooting to obtain ST analysis.”

The nurses said they witnessed the devices missing episodes of arrythmia, but there were no alarms or no history recorded.

One patient had a cardiac arrest that required cardio-pulmonary resuscitation (CPR), but the device didn’t react to the incident as it should have, the report said.

They also cited examples of occasions when blood pressure was not monitored accurately, risking inappropriate treatment.

Some of the problem associated with the monitors is related to poor contact points on electrocardiogram leads — which connect to patients, the report said. There is a complaint about the type of metal leads used with the devices, including the ongoing issue of lead fractures and terminal corrosion and the nurses asked administrators for an adequate supply of better leads.

In the case of the two patients who bled into their beds, the monitors didn’t work properly even though they were set up correctly, the nurses said in the report.

Then there’s the problem of noise.

“We are always silencing and troubleshooting in all units. This noise level is amplified in beds around the central station in the (critical care unit),” the report said, adding patients were not only losing sleep, but they were agitated, fearful that the equipment is not working right and felt the nurses didn’t know what they were doing.

And besides the false alarms, the nurses said they were unable to hear alarms when patients were in isolation rooms with their door closed.

They also said clinical specialists and biomedical staff told nurses to turn off alarms, a violation of their critical care policy.

They acknowledged ongoing attempts to resolve the issues, but said communication has been sporadic and inconsistent.

“We have received emails and troubleshooting tidbits, however we have not received an overall action plan, with comprehensive education for all critical care nurses. As per Eastern Health policy, we have documented occurrences, with little or no feedback,” they said.

And while Eastern Health has said it assigned a nurse specifically to monitor the wireless devices, staff also asked for a resource nurse for every shift. That nurse would be specifically tasked to troubleshoot the equipment.

The nurses also wanted all the occurrences investigated and evaluated and a detailed action plan on the problems with the monitors.

The report also said the alarms can be turned off accidently.

“We take our duty to maintain the standards of nursing in critical care very seriously. We will not compromise patient care,” the nurses said in the report.

A hundred nurses have signed a petition to Eastern Health over concern about the monitors.

In an email response to The Telegram’s request for reaction, Eastern Health acknowledged concerns about the leads, and said it implemented a change in practice for cleaning them.

“Since this change has been implemented, reports of the metal contacts breaking down prematurely have diminished. In addition, Eastern Health has approached a manufacturer of leads to suggest and design a lead alternative that has been requested by staff. It is anticipated to have an alternative lead in place within the next few months,” a spokeswoman said in the email.

“It should be noted that the leads currently being used at the Health Sciences Centre are also being used in other Eastern Health facilities, with no reported issues. As well, these leads are also used by the manufacturer across North America and the rest of the world, with no known reported issues.”

Eastern Health also said it had a resource nurse in the early stages of implementation, but not now. However, the authority said it has provided additional training to nurses so they can help each other.

In response to the detailed action plan nurses want, it should be completed in the coming weeks, Eastern Health said.

As for the incidents with patients, Eastern Health said it has publicly acknowledged 250 occurrence reports filed since the equipment was installed. And while it can’t speak to specifics, the authority insists none of the instances caused permanent harm to the patients as a direct result of the new equipment being used.

Any issues with the equipment prior to September 2011 when the wireless technology was brought in have been attributed to change and staff having to adapt. Eastern Health said it addressed those issues with more training and one-on-one attention for staff.

“Eastern Health is committed to continuously work with its nursing staff, including physicians and the manufacturer, to address any areas of concern. Eastern Health will continue to do so until all issues have been resolved,” the email stated.

“As such, Eastern Health is confident in its monitoring equipment, and is committed to provide quality care to its patients, clients and residents.”

Both Eastern Health and Sullivan have said the monitors have more benefits than issues and more than 2,600 of the same machines are being used across Canada, including at the Hospital for Sick Children in Toronto.

The gap between what is technically possible in medicine and what the average North American can expect from his doctor and his hospital has never been greater. For a small few - people like Dick Cheney - modern medicine is willing and able to go to great extremes. A decade after the first complete mapping of the human genome at a cost of billions, personal mapping is now available for anyone with $10,000. Within a few years, the price will drop to a $1,000 or less. Standford not only mapped a subject once but several times over a year such that they were able to watch molecular changes signalling the onset of diabetes and take steps to prevent it. There are no shortage of medical breakthroughs but the lag in their adoption as best practice in the health care system is extremely long and growing. Meanwhile hospital acquired infections, which result from a combination of the abuse of antibiotics and lack of sanitation, are estimated to kill one hundred thousand patients in the U.S. each year. In both Canada and the U.S., sanitation and hygiene have become a chronic problem. An expose' by CBC's Marketplace has demonstrated just how badly hospital units are cleaned. Cleaners, who typically spend less time cleaning a hospital room than a hotel room, invariably leave behind feces and body fluids with a whole host of viral and bacteriological contaminants - including the deadly C. difficile - for the unsuspecting new patient whose immune system is often already compromised. At the heart of the problem is a costing model used by governments and hospital boards which is fundamentally flawed. The model is fixated on component costs at the micro level while ignoring the bigger picture. It is a system which is all but oblivious to the financial and health benefits of prevention. There are many facets of prevention. The prevention of a larger cost by a much smaller one, as exemplified in the failure to maintain reasonable standards of sanitation and hygiene, is a concept that is seemingly beyond the grasp of those responsible for health care analytics in our modern day institutions. When someone visits you in your hospital room these days, consider it more than an act of kindness. It is almost an act of bravery.

OK, I am not a nurse, but, seems to me that Eastern Health, once again, is not listening to the "people". Ms Kaminski is belittleing the staff who work with this equipment and sounds a bit too defensive to me. The original story said that two patients "bled out" and another required CPR because of faulty alarms. That, to me, sounds pretty darn serious. I wouldn't want to have been either one of those patients!!!

If these monitors are being used all over North America, why is this the only place with formal complaints? Because that's what WE do, complain about everything. From my understanding, these devices are in place to ASSIST nurses, as we all know they are busy and cannot provide constant supervision over a patient. I still agree with using them, considering they are used all over the country and any monitor which can diagnose a problem quickly and without a nurse present is always a positive!

Agreed. My father has had two longer stays in hospital, one at St Clare's where the nurses and care were wonderful, and most recently at HSC where that wasn't always the case. With patient call buttons being ignored, phones ringing and being ignored, up to 7 visitors per bed allowed in a room with four beds, and so much discussion about breaks, ie, who's on one, who should be on one, who needs another one, who didn't get one.....maybe the equipment in question is just being ignored too. A little more emphasis on the actual patients' needs and less on the nurses' might be a step in the right direction.

ExPatient

March 27, 2012 - 12:26

Maybe the equipment alarms were missed amongst all the patient call bells and phones ringing that were constantly being ignored whenever I was at HSC last fall visiting my mother. Seems all that got noticed was who was on break, who should be on break, who didn't get a break.......more attention to patients' needs and less to nurses needs' might be the first step to resolving this issue. To listen to Debbie Forward, all nurses care about - especially during contract negotiations - is the quality of patient care. But anyone who has spent a lot of time as a patient, or has visited a loved one at the HSC recently, can tell you a whole different story.

Raddishes

March 27, 2012 - 16:00

What Centres are they used in? Why would the nurses kick up a big fuss for nothing, just to complain. They cared for my mother before like I said and they don't complain.

ken

March 27, 2012 - 18:23

you have no idea what you're talking about are are therefore contributing nothing but ignorance to the matter.

Timmy turner

March 28, 2012 - 07:25

Monitors that 'diagnose' patients without a nurse being present? Get real folks - this is not Star Trek. Monitors are merely a tool - it takes a trained healthcare professional to interpret the alarms. There are many false alarms due to artifact - you wil not see an experienced ICU nurse jump at every alarm because they have the skill to identify what is important
The cardiac monitor is a useful tool - but in the end it is just a tool

sealcove

March 27, 2012 - 10:06

Guess the nurses don,t know what they are talking about, Don,t worry the government has your best interest at heart,the question is who do you believe Nurses of course they work with the equipment everyday

this is not surprising. EH provides us with cheap, s*** equipment to try and take care of patients. when they malfunction, we are left to try and troubleshoot the problem, patient care is compromised & we are ultimately at fault. quit bringing in junk, and upgrade us appropriately so patients can be cared for properly!